Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia

PurposeTo explore an effective surgical treatment for pain in the distribution area of the maxillary branch of trigeminal nerve (TN).Materials and methodsTwenty-six patients with pain in the distribution of the maxillary branch of TN were followed up after they had undergone pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route.ResultsIn all cases, the pain initially resolved after operation, with anaesthesia or paraesthesia in the operated side of the maxillary nerve-distributed area. After a mean follow-up period of 24 (range 3–36) months, 19 (73.08%) of the 26 patients had an excellent response, 5 (19.23%) had a good response, 2 (7.69%) had a fair response, and none (0%) had a poor response. One patient had a recurrence with palatal pain 3 months after the operation.ConclusionsThe maxillary sinus route can provide a clear vision for sectioning of the maxillary nerve. This new surgical technique has proven to be safe and effective. It provides another option for the weak elderly who are intolerant of craniotomy or patients who have contraindications for craniotomy when radiofrequency thermocoagulation (RFT) and percutaneous glycerol neurolysis (PGR) treatment is not possible.     

经圆孔外口神经切断术治疗上颌神经痛的临床应用(附48例报告)

目的 :为解决病人三叉神经痛 ,提高手术治疗效果 ,减少术后复发 ;方法 :采用经上颌窦在翼腭凹行上颌神经切断术治疗三叉神经痛 ;结果 :经上颌窦在翼腭凹圆孔外口处可高位切断上颌神经 ;经 48例术后 10～ 2 0月的随访 ,复发者 1例。结论 :该治疗方法新颖 ,手术创伤小 ,视野清楚 ,术后恢复快。治疗效果好。该径路为手术治疗增添了新的方法     

Transantral distraction devices in correction of severe maxillary deformity in cleft patients

Maxillary advancement by Le Fort I osteotomy in cleft patients has an average relapse of about 40-60 percent. With extraoral distraction devices it is possible to obtain an almost unlimited advancement of the upper jaw. Due to the social problems the retention period is normally reduced to some monthes. A relapse of 10-25 % can be seen in these cases. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. The objective of this study was to present our experience in the treatment of maxillary deficiency in cleft patients using transantral internal distraction devices. The distraction procedure was successfully accomplished in seventeen patients. For all the seventeen patients maxillary distraction device designed by Konrad Wangerin was used. The distraction distances were 8 to 24 mm. Preoperative, postoperative, and follow-up (12 and 24 months) lateral cephalogram measurements were compared including angular and linear changes. A good new bone was found that was formed in distraction pitch between lines of osteotomy. After distraction of median facial zone, occlusion and profile of soft tissues were considerably improved. All patients after postoperative time required final orthodontic treatment and their final occlusal relationships were satisfactory. The transantral distraction device is a new option for the treatment of severe maxillary hypoplasia in cleft patients.     

Cryoneurotomy in the management of intractable trigeminal neuralgia

In this paper we describe the effects of peripheral cryoneurotomy on a consecutive series of patients with intractable trigeminal neuralgia (TN) who had been treated by a single surgeon over a ten-year period. The results of 55 patients who underwent a total of 102 cryoneurotomies were documented. The age at first cryofreeze was 64 (30-92) years with 24 males and 31 females. Thirty-five had primary TN and 20 secondary TN. The first cryofreeze resulted in 28.2 (5-144) pain free months. Twenty-nine had a second freeze which lasted 34 (2-100) pain-free months and 13 had a third cryofreeze which lasted 26 (1-108) pain free months. Two patients had further freezes. Thirty-four of the primary TN patients had prolonged freedom from pain with one dying perioperatively. The 20 patients with secondary TN had shorter period of pain relief (p < 0.05) and one committed suicide. The procedure of peripheral cryoneurotomy is recommended for older, unwell patients with primary TN that is refractory to medical or neurosurgical treatments. It is less effective for dysaesthesia secondary to traumatic nerve injuries.     

Transantral odontoma. A case report.

Described is the case of a 30-year-old black man with a history of acute pansinusitus, headaches, and intermittent right nasal stuffiness. The history, clinical signs and symptoms, and roentgenographic findings were consistent with the diagnosis of a transantral complex odontoma. Finding of this entity is extremely rare in this region.     

翼腭管注射无水乙醇治疗上颌神经痛报告

目的:探讨翼腭管注射无水乙醇治疗原发性上颌神经痛的价值.方法:回顾近5年78例患者的临床资料作为研究对象进行分析.结果:观察5年,术后3个月有74.4%患者疼痛全部和部分消失,6个月有70.5%,1年有67.9%,2年有57.7%,5年时只有51.3%.结论:患者在治疗后疼痛完全或部分消失的比例随时间推移而降低.此治疗方法虽不能彻底根治,但方法简单,创伤小,患者容易接受,对缓解症状减轻痛苦,不失为行之有效的方法.     

X线下2种穿刺方法射频热凝治疗上颌神经痛的疗效分析

目的研究X线下经皮穿刺卵圆孔和圆孔射频治疗上颌神经痛临床疗效对比。方法对2008—2015年收治住院的69例单纯上颌神经痛患者随机分为2组。A组:33例,穿刺卵圆孔,患者采用Hartel前入路法,根据射频针尖至耳-床线的垂直距离确定入颅深度后,行射频热凝。B组:36例,穿刺圆孔,采用弯针穿刺进入翼腭窝,局部注射2%利多卡因1 m L,X线定位圆孔穿刺方向,再穿入圆孔,X线下定位确定进入圆孔后行射频治疗。结果所有患者均顺利完成手术,穿刺针均准确位于圆孔内和卵圆孔内,治疗后疼痛即刻缓解,无严重并发症发生,眶下区及上腭均有感觉迟钝。所有患者随访6个月~2年,两组3天有效率、术后复发率差异比较无统计学意义(P>0.05)。两组在非患支神经损伤的发生率差异显著(P<0.05)。手术时间A组平均48.79 min,B组平均50.32 min;术中疼痛评分A组平均7.48分,B组平均2.92分;术中患者满意度评分A组平均2.64分,B组平均5.36分。两组在手术时间无统计学差异,在术中疼痛评分及患者满意度评分具有统计学差异。结论经翼腭窝穿刺圆孔治疗上颌神经疼痛具有一定的优势,值得推广。     

Stability consideration for internal maxillary distractors.

PURPOSE: Stability in distractor design ensures distraction osteogenesis healing with good bone regenerate formation. The aim of this study was to compare the holding strengths of different fixation systems for maxillary distractor design on bone pieces of different thicknesses. MATERIAL AND METHODS: Cross-sectional images of 10 dry skulls were obtained by computer tomography and the bone thickness of the maxillae were measured according to five individual anatomical regions (paranasal, infra-orbital, posterior sinus wall, zygomatic and alveolar regions). According to the measurements, the screws of 1.5 and 2mm in diameter and the three-screw mini-plates in triangular and straight configurations were evaluated for holding strength by pull-out tests on fresh animal bone pieces of defined thickness. RESULTS: The paranasal and zygomatic regions of the human skulls had the thickest cortical bone (4mm) followed by the alveolar region (2mm). In the bones of 2 and 4mm thickness, the 2mm screws were confirmed stronger than the 1.5mm ones in pull-out tests. However, the pull-out behaviour of screws of different diameters in 1mm thick bones and the mini-plates in two different configurations showed no significant differences. CONCLUSION: This study confirms that the paranasal and zygomatic bones are the thickest for fixation of internal maxillary distractors. Fixation screws of 2mm diameter in either triangular or straight miniplates can produce good stabilization for distractors.     

Palatal approach for maxillary alveolar distraction.

PURPOSE: The purpose of this report was to describe a surgical technique for performing alveolar distraction in the upper jaw via a palatal approach. PATIENTS AND METHODS: To illustrate this technique we report 2 clinical cases in which palatal-approach alveolar distraction was used to rectify insufficient alveolar rim height. The first case involves a 50-year-old man with atrophy of the alveolar rim in the posterior upper jaw. From the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and 2 Lead System distractors (Leibinger, Kalamazoo, MI) were placed. The second case involves a 23-year-old woman with a bone defect in the alveolar rim in the premaxillary sector of the upper jaw. Again, from the palatal side, a transport segment pedicled to the vestibular mucosa was cut, and a single Lead System distractor was placed. RESULTS: In both cases the height of the alveolar rim was successfully increased by 8 mm, allowing placement of three 12-mm implants in case 1, and two 12-mm implants in case 2. CONCLUSIONS: We recommend a palatal approach and intraosseous distractors for alveolar distraction in the upper jaw.     

Tissue-engineered bone for maxillary sinus augmentation.

PURPOSE: Autologous, allogenic, and alloplastic materials for bony reconstruction in the craniomaxillofacial region have specific drawbacks stimulating the ongoing search for new materials. Cultivated skin and mucosa grafts are in clinical routine use in head and neck reconstruction but so far, to the best of our knowledge, no successful clinical application has been described of periosteum-derived tissue-engineered bone for augmentation of the edentulous posterior maxilla. PATIENTS AND METHODS: In a clinical study, augmentation of the posterior maxilla was carried out using a bone matrix derived from mandibular periosteum cells on an Ethisorb (Ethicon, Norderstedt, Germany) fleece. In this report, we show the fabrication of the matrix, clinical application, and results in 27 patients. RESULTS: In 18 patients, an excellent clinical, radiologic, and histologic result could be proved 3 months after augmentation. Histologically, the bone biopsy samples from these patients revealed mineralized trabecular bone with remnants of the biomaterial. An unsuccessful result was found in 8 cases with a more extended augmentation procedure. The clinical inspection 3 months after augmentation showed almost no formation of new bone. In contrast, a replacement resorption with connective tissue was found. This may be the result of failure of the initial supply of the cells embedded within large cell-polymer constructs with sufficient oxygen and nutrients to sustain their survival and proliferation and allow for the integration of the developing tissue within the surrounding tissue. CONCLUSION: Our achieved results suggest that periosteum-derived osteoblasts on a suitable matrix can form lamellar bone within 3 months after transplantation and provide a reliable basis for simultaneous or secondary insertion of dental implants.     

Herpes zoster post-herpetic neuralgia.

Post-herpetic neuralgia (PHN) is the most frequent complication of herpes zoster and often results in significant morbidity and a reduction in the patient's quality of life. The peripheral nerve injury that occurs during the acute phase of herpes zoster (HZ) leads to an abnormal tonic impulse discharge from primary nociceptive afferent neurons which induce slow temporal summation.This "wind-up" phenomenon is responsible for continuous partial depolarisation of second-order neurons with increased spontaneous impulse discharge and expanded receptive fields within the dorsal horn nociceptive neurons.The abnormal central processing involves the activation of N-methyl-D-aspartate (NMDA) receptors resulting in neuropathic pain, characterized by spontaneous pain, hyperalgesia and allodynia which is typical of PHN. In addition, tonic input from non-nociceptive AB afferent neurons, maintained by sympathetic efferent activity, contribute to the development and maintenance of neuropathic pain in general, and a burning sensation in particular.     

Impression technique for complete maxillary immediate denture.

A technique for making complete maxillary immediate denture impressions has been described. With this procedure impressions of the edentulous area and remaining dentition can be made in sections and they can be removed from the mouth joined together.     

Periodontal surgery for the maxillary anterior area.

A modified surgical technique, aimed at the conservation of maxillary anterior esthetics, has been proposed for the treatment of maxillary anterior periodontal pathoses that do not respond to traditional, nonsurgical approaches. The modified resective technique gives selective access to the periodontally diseased root surfaces while allowing the periodontist to avoid facial areas with shallow pockets. This paper describes the technique in detail and discusses its indications, advantages, and disadvantages.     

Anterior rests for maxillary removable partial dentures.

Positive anterior rests were shown to be an essential element of design when considering stress distribution with a removable partial denture involving anterior teeth. Proximal plates often added stability and reduced stress accumulation in any one region. Distobuccal forces on the extension base adversely affected the primary canine abutment. Forces in the regions of the anterior base and central incisor abutment produced the most widespread transmission of stress throughout the arch. Greater stress throughout the arch was observed when forces were applied to the central incisor rather than to the right canine abutment. There is a need for established criteria of rest form and placement. Guidelines for using the natural crown as opposed to a positive rest seat in a restoration are needed. Continuing studies of other anterior rest forms should increasingly clarify this phase of treatment planning. The dentist should recognize the need for structural integrity in the anterior maxillary segment when designing removable partial dentures. A practical, defensible rationale for the routine use of maxillary anterior teeth as removable partial denture abutments must be established.     

Mechanisms of early maxillary growth-implications for surgery.

Previous studies of the effects of surgical techniques on facial growth (with one exception) have been done in dogs, pigs, rabbits, and rats; the phylogenetically closer nonhuman primate serves as a better model. Current data, obtained from resection of the nasal septum in baboons, indicate that proper coordination of timing and surgical technique can cause arrest of growth in the upper part of the face.